Stephanie J. Wilson

Daily verbal and nonverbal expression of osteoarthritis pain and spouse responses.

Summary A daily diary study of osteoarthritis patients and their spouses suggests that nonverbal and verbal channels of pain expression together promote help‐oriented spouse responses and mitigate punishing ones. Abstract The current study applied a model of pain communication to examine the distinction between verbal and nonverbal pain expression in their prediction of punishing, empathic, and solicitous spouse responses to patient pain. It was hypothesized that on days when patients engaged in more nonverbal expression, spouses would respond more positively (ie, with less punishing and more solicitous and empathic behavior). The same pattern was predicted for verbal expression. In addition, it was expected that associations between patient nonverbal pain expression and positive spouse responses would be strengthened, and that the association with punishing responses would be weakened, on days when levels of verbal pain expression were higher than usual, regardless of daily pain severity. In a 22‐day diary study, 144 individuals with knee osteoarthritis and their spouses completed daily measures of pain expression, spouse responses, health, and affect. The predicted positive main effect of nonverbal expression on empathic and solicitous responses was supported by the data, as was the positive main effect for verbal pain expression. Results from moderation analyses partially supported our hypothesis in that patients’ nonverbal pain expression was even more strongly related to empathic and solicitous spouse responses on days of high verbal pain expression, and patients were buffered from spouse punishing responses on days when both nonverbal and verbal expression were high. These findings suggest that pain expression in both verbal and nonverbal modes of communication is important for positive and negative spousal responses.

Daily Spousal Responsiveness Predicts Longer-Term Trajectories of Patients’ Physical Function:

Everyday interpersonal experiences may underlie the well-established link between close relationships and physical health, but multiple-timescale designs necessary for strong conclusions about temporal sequence are rarely used. The current study of 145 patients with knee osteoarthritis and their spouses focused on a novel pattern in everyday interactions, daily spousal responsiveness—the degree to which spouses’ responses are calibrated to changes in patients’ everyday verbal expression of pain. Using couple-level slopes, multilevel latent-variable growth models tested associations between three types of daily spousal responsiveness (empathic, solicitous, and punishing responsiveness), as measured during a 3-week experience-sampling study, and change in patients’ physical function across 18 months. As predicted, patients whose spouses were more empathically responsive to their pain expression showed better physical function over time compared with those whose spouses were less empathically responsive. This study points to daily responsiveness, a theoretically rooted operationalization of spousal sensitivity, as important for long-term changes in patients’ objective physical function.

COMT and OPRM1 Genotype Associations with Daily Knee Pain Variability and Activity Induced Pain.

Abstract Background Osteoarthritis (OA) of the knee is a common and increasingly prevalent condition that is one of the primary causes of chronic pain. Staying physically active protects against disability from knee OA but is also very challenging. A critical but unexamined question is whether patients at greatest risk for becoming less active are those with a genetic predisposition for greater sensitivity to daily pain. Aims We examined day-to-day variability in knee OA pain for patients with different variants of catechol-O-methyltransferase (COMT) and mu-opioid receptor (OPRM1) single nucleotide polymorphisms (SNPs), and whether patients with a specific genotype experience more pain following daily physical activity. We predicted that patients having one or more copies of the Met158 allele of COMT rs4680 (A-A or A-G) and one or more copies of the Asp40 allele of OPRM1 rs1799971 (A-G or G-G) would show greater pain variability. We expected to see the same pattern for these SNPs with regard to moderation (i.e., exacerbation) of the activity-pain association. Methods A total of 120 knee OA patients reported on their pain 3 times per day over 22 days using handheld computers, and wore an accelerometer to capture daily physical activity. Multilevel modelling was used to examine the magnitude of within-person variability in pain by genetic group. We also examined whether lagged, within-patient associations between level of activity in the afternoon (i.e., minutes of moderate intensity activity, and number of steps) and knee pain at the end-of-day were moderated by between-patient differences in genotype. Results Regarding OPRM1 rs1799971 (Asn40Asp), patients with two copies of the Asn40 allele showed the greatest day-to-day pain variability. Regarding COMT rs4680 (Val158Met), patients with the Val/Val genotype showed the greatest pain variability and also experienced the greatest increase in pain as a result of physical activity. A similar pattern of findings across bi-directional temporal lags was consistent with a negative feedback loop between daily physical activity and pain according to genotype. Consistent with some previous studies, there were no significant between-person differences in daily pain when comparing patients according to COMTrs4680, or OPRM1 rs1799971. Conclusions This study provides preliminary evidence that patients with certain genotypes for COMT rs4680 and OPRM1 rs1799971 (G-G and A-A, respectively) experience more variability in their day-today pain and exacerbation of pain after daily physical activity compared to patients with other genotypes. Our findings should be replicated in larger study populations. Implications Previous clinical research has focused primarily on differences in average level of pain between patients with and without a specific genotype. Assessment of within-person variability through repeated measurements in daily life enhances the reliability, power, and ecological validity of phenotypic measurement. Perspective This study provides preliminary evidence that patients with certain variations in the COMT and OPRM1 SNPs experience more variability in their day-to-day pain and exacerbation of pain after daily physical activity.

Interpersonal Behavior in Couple Therapy: Concurrent and Prospective Associations with Depressive Symptoms and Relationship Distress

Abstract Objective: This study investigated associations between couples’ interpersonal behavior, depressive symptoms, and relationship distress over the course of couple psychotherapy. Method: After every other session of Integrative Systemic Therapy (M = 13 sessions), N = 100 individuals within 50 couples rated their in-session affiliation and autonomy behavior using the circumplex-based Structural Analysis of Social Behavior Intrex. Concurrent and prospective associations of interpersonal behavior with depressive symptoms and relationship distress were evaluated via multivariate multilevel modeling using the Actor-Partner Interdependence Model. Results: An individual’s hostility, as well as the partner’s hostility, positively predicted an individual’s concurrent depressive symptoms and relationship distress, as well as his or her relationship distress at the following session. Partner hostility during one session predicted an individual’s subsequent depressive symptoms. During sessions in which individuals controlled the partner, and separated themselves from the partner, they reported more concurrent depressive symptoms and relationship distress, and more subsequent relationship distress. When partners separated themselves, individuals reported more concurrent depressive symptoms and relationship distress, and more subsequent relationship distress. Conclusions: Results underscore the importance of couples’ in-session affiliation and autonomy behavior in the treatment of depressive symptoms and relationship distress within couple therapy.

Couples’ day-to-day pain concordance and marital interaction quality:

Chronic pain is a common stressor in couples’ daily lives, but little is known about couples’ day-to-day pain concordance (i.e., agreement regarding one partner’s level of pain) and its relevance to both partners’ daily marital interaction quality. Using 22-day diaries of patients diagnosed with knee osteoarthritis (OA) and their spouses, the current study sought to quantify the degree of daily fluctuation in both partners’ reports of patient pain, pain concordance, and marital interaction quality as well as assess the links between daily concordance and marital tension and enjoyment. Half of the variability in patient–spouse pain concordance and marital interaction quality was attributable to daily fluctuations in these experiences. Furthermore, after accounting for global marital satisfaction, on days when spouses overestimated pain, patients enjoyed marital interactions more, whereas spouses themselves experienced greater tension. Findings underscore the importance of examining pain concordance at the daily level, pain agreement’s significance for everyday marital function, and the potential challenge chronic illness poses for partners in daily life.

Capturing patients’ symptom expression and spouses’ cardiovascular responses continuously: The feasibility of examining a mechanism of disease risk in the home.

Introduction: Spousal caregivers face increased cardiovascular risks; lab studies suggest that autonomic reactivity to patients’ physical suffering may play a role. To evaluate this mechanism in daily life, our pilot study characterized the feasibility of recruiting couples for a multimethod, in-home assessment. We examined the usability of the resulting data in an effort to link spousal cardiovascular changes to patient pain expression during couples’ everyday interactions. Method: For two 48-hr periods, individuals with rheumatoid arthritis (RA) and their partners wore heart monitors while audio-recordings captured couples’ in-home interactions. Interbeat intervals were subsetted in 1-, 2-, and 5-min windows before and after each pain expression. Pre-post difference scores in high-frequency heart rate variability (HF-HRV) and heart rate were examined. Results: Of the 17 screened RA patients, 11 were ineligible, and 3 partners declined. The 3 participating couples completed all study activities. The resulting 288 hr of recordings were coded for patients’ RA symptom expression, which varied from none to an average of 11 times daily. One couple had sufficient data for physiological analysis: Contrary to prediction, spouse HF-HRV significantly increased after patient symptom expression. Conclusions: Recruitment rates mirrored other couples studies, and enrolled couples complied with study procedures. In-home conversations were reliably coded and successfully linked to spousal ongoing cardiovascular activity. Preliminary findings highlight the importance of optimal sampling windows and suggest symptom expression as a relevant process for some spouses but not others. We offer recommendations for efficiently scaling up the method in future studies.

Loneliness and Telomere Length: Immune and Parasympathetic Function in Associations With Accelerated Aging

BACKGROUND Lonely peoples heightened risks for chronic health conditions and early mortality may emerge in part through cellular aging. Lonelier people have more severe sympathetic responses to acute stress, increasing their risk for herpesvirus reactivation, a possible path to shorter telomeres. Parasympathetic function may modulate this risk. PURPOSE The current study aimed to examine the associations among loneliness, herpesvirus reactivation, and telomere length, with parasympathetic activity as a moderator, in healthy middle-aged and older adults. METHODS A sample of 113 healthy men and women of ages 40-85 provided blood samples that were assayed for telomere length, as well as the latent herpesviruses cytomegalovirus (CMV) and Epstein-Barr virus (EBV). They also provided heart rate variability (HRV), a measure of parasympathetic activity, and reported on their feelings of loneliness. RESULTS Lonelier people with lower HRV (i.e., lower parasympathetic activity) had greater CMV reactivation and shorter telomeres compared with their less lonely counterparts, above and beyond demographics, health behaviors, resting heart rate, and social network size. However, loneliness was not associated with viral reactivation or telomere length among those with higher HRV. In turn, greater CMV and EBV reactivation was associated with shorter telomeres. CONCLUSIONS Taken together, these data implicate parasympathetic function in novel links between loneliness and accelerated cellular aging.

Caregiver Vulnerability and Brain Structural Markers: Compounding Risk

Caregiving strain confers an increased risk for allcause mortality. Intensive caregiving can produce a range of adverse mental and physical health consequences, best documented among dementia family caregivers. The provocative population-based study of the elderly by Smagula and colleagues, drawn from a random, stratified sample, showed that more than 82% of those spouses who helped their partner with four or more of the 12 activities of daily living (ADLs) or instrumental activities of daily living (IADLs) reported strain, consistent with other literature. Caregivers who helped their partner with three or fewer IADLs, however, were 55% more likely to report strain if they had magnetic resonance imaging–assessed white matter grades of 4 or greater. This latter finding is quite novel and raises the question of whether brain structural pathology may augment caregiver strain for some individuals. The findings are particularly notable in view of the very broad definition used for caregiving: These researchers only required that the impaired spouse have difficulty with at least one ADL or IADL, “due to physical or health problems or problems with confusion.” Accordingly, it is likely that their sample was considerably less burdened and less distressed than the caregivers who have received the most attention: spousal caregivers for dementia sufferers, the population most heavily represented in the studies they cite. Furthermore, their research participants only needed to meet criteria as caregivers at a single time point, so that spouses who were only functioning as temporary or transient caregivers following a partner’s acute medical problems would nonetheless be classified as caregivers in their data. As a consequence of these factors, their data are likely to underestimate the actual impact of caregiving for a severely physically or cognitively disabled spouse among individuals with brain structural pathology.